Provider Demographics
NPI:1093552028
Name:JAKUBOWSKY, JOLENE ELIZABETH (CNM)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:ELIZABETH
Last Name:JAKUBOWSKY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:ELIZABETH
Other - Last Name:COYER/SIREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19781 EVERHILL AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-8676
Mailing Address - Country:US
Mailing Address - Phone:952-288-6584
Mailing Address - Fax:
Practice Address - Street 1:16802 145TH AVE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-3208
Practice Address - Country:US
Practice Address - Phone:320-362-0476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN589176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife